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Cognitive Behaviour Therapy

CREST Cognitive Behaviour Therapy

Research demonstrates that cognitive biases in attention, memory, and interpretation play a key role in the aetiology and maintenance of emotional disorders. Evidence suggests that CBT interventions modify biases yielding therapeutic benefits for clinically anxious patients.

A large body of evidence accumulated over the years supports the notion that threat-related information have a special propensity to capture visual attention, especially in individuals classified as highly anxious (Mathews & MacLeod, 1994). An attentional bias can be defined as a systematic tendency for highly anxious individuals to prioritise the processing of threat-related stimuli over neutral stimuli (MacLeod, Mathews, & Tata, 1986; Mogg & Bradley, 1998). This modus operandi, rather than representing an index of accuracy (Beck, et al., 1985), can be viewed in terms of the adaptive value associated with biased attentive processing that facilitates the rapid detection of danger in the environment, thus enabling an effective response to threat (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van Ijzendoorn, 2007). 

Numerous studies have revealed an attentional bias towards threat-related information across the range of anxiety disorders. For instance, biased attentive processing of threat has been found in GAD (Bradley, Mogg, Millar, &White, 1995; Bradley, Mogg, White, Groom, & de Bono, 1999; Mogg, Bradley, Williams, & Mathews, 1993; Rinck, Becker, Kellermann, & Roth, 2003), PTSD (Bryant & Harvey, 1995; McNally, Kaspi, Bradley, & Zeitlin, 1990), OCD (Amir, Najmi, & Morrison,2009; Cisler & Olatunji, 2010; Foa, Ilai, McCarthy, Shoyer, & Murdock, 1993; Tata, Leibowitz, Prunty, Cameron, & Pickering, 1996), social phobia (Amir, Elias, Klumpp, & Przeworski, 2003; Becker, Rinck, Margraf, & Roth, 2001), specific phobia (Öhman, Flykt & Esteves, 2001; Rinck, Reinecke, Ellwart, Heuer, & Becker, 2005), and panic disorder (Buckley, Blanchard, & Hickling, 2002; Horenstein & Segui, 1997).

There is a growing body of evidence that suggests that it may be possible to modify these biases in cognitive processes which can yield therapeutic benefits for clinically anxious and depressed patients. Adrian Wells has been at the forefront of developments regarding attentional training which represents a key feature in the self-regulatory executive function model (Wells & Matthews, 1994). Developed by Wells (1990), attentional training technique (ATT) is an intervention strategy initially developed to form one part of a therapeutic treatment programme. Formulated around three auditory-based attention tasks, individuals work through three phases of training beginning first with focusing on specific sounds emanating from various locations whilst minimising the impact of distracting sounds (i.e., selective attention training). During the second phase, individuals practice the rapid switching of attention between sounds (i.e., attentional switching training). The final phase, albeit briefer, requires the individual to attend to all sounds at the same time (i.e., divided attention training). ATT has been applied in the treatment of hypochondriasis (Cavanagh & Franklin, 2000; Papageorgiou & Wells, 1998), major depression (Papageorgiou & Wells, 2000), auditory hallucinations (Valmaggia, Bouman, & Schuurman, 2007), panic and social phobia (Wells et al., 1997).

Attentional training has also been implemented using a modified version of the visual dot-probe task (MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002). Throughout a number of experimental trials the probe consistently appears in locations previously occupied by either a neutral or threat-related stimulus, prompting participants to attend to stimuli (i.e., neutral or threat-related) that reliable predict the probe’s spatial location. Based on this attention training method, both the symptoms of anxiety as well as the accompanying attentional bias were reduced in individuals with sub-clinical anxiety (Mathews & MacLeod, 2002), social anxiety (Amir, Weber, Beard, Bomyea, & Taylor, 2008), generalised anxiety disorder (Amir, Beard, Burns, & Bomyea, 2009) and obsessive compulsive disorder (Najmi & Amir, 2010). The rationale behind attention training is that individuals learn to divert their attention away from threat (i.e., avoidance of threat) over a large number of experimental trials, thus preventing negative thoughts becoming activated and entering into the realm of consciousness (Mobini & Grant, 2007). Interestingly, mindfulness-based training is increasingly becoming available in therapeutic settings and recent studies have shown that meditation skills can also lead to improvements in the functioning of specific subsystems of attention (Jha, Krompinger, & Baime, 2007).

Selected Publications.

Fox, E., Dutton, K., Yates, A., Georgiou, G.A., & Mouchlianitis, E. (Submitted). Attentional control and suppressing negative thought intrusions in pathological worry. Clinical Psychological Science .

Ashwin, C., Holas, P., Broadhurst, S., Kokszha, A., Georgiou, G. A., & Fox. E. (2012). Enhanced anger superiority effect in generalized anxiety disorder and panic disorder. Journal of Anxiety Disorders, 26 (2), 329-336

Spada, M. M., Georgiou, G. A., & Wells, A. (2010). The relationship between metacognitions, attentional control and state anxiety. Cognitive Behaviour Therapy, 39, 64-71.

Fernie, B. A., Spada, M. M., Nikčević, A. V., Georgiou, G. A., & Moneta, G. B. (2009). Metacognitive beliefs about procrastination: Development and concurrent validity of a self-report questionnaire. Journal of Cognitive Psychotherapy, 23 (4), 283-293.

Russo, R., Whittuck, D., Roberson, D., Dutton, K., Georgiou. G. A., & Fox, E. (2006). Mood congruent free recall bias in anxious individuals is not a consequence of response bias. Memory, 4, (4), 393-399

Fox, E., Russo, R., & Georgiou, G. A. (2005). Anxiety modulates the degree of attentive resources required to process emotional faces. Cognitive, Affective, & Behavioural Neuroscience, 5, 396-404.

Georgiou, G. A., Bleakley, C., Hayward, J., Russo, R., Dutton, K., Eltiti, S., & Fox E. (2005). Focusing on fear: Attentional disengagement from emotional faces. Visual Cognition, 12, 145-158.

Keogh, E., Dillon, C., Georgiou, G. A., & Hunt, C. (2001). Selective attentional biases for physical threat in physical anxiety sensitivity. Journal of Anxiety Disorders, 15, 299-315.